Improving India's health care landscape

“Good health is the foundation of human progress and prosperity”

“Future belongs to societies investing in healthcare” 

– PM Narendra Modi

The Government of India’s vision under the leadership of Prime Minister Narendra Modi is to provide affordable and accessible quality healthcare to the country’s most vulnerable and last-mile population. Towards this, the central government announced the landmark Ayushman Bharat programme, which is a unique integration of primary and promotive healthcare through Ayushman Bharat-Health and Wellness Centres (AB-HWCs) and assured linkages for secondary and tertiary care through Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). With 160,000 AB-HWCs operational and more than 2.1 crore wellness sessions organised across the country, the government’s commitment towards the health and wellness of its citizens is evident.
 
More than 238 million Ayushman cards have been issued to the poorest of the poor and they can avail of free treatment worth up to Rs 5 lakh at any of the 28,351 empanelled hospitals across India. With more than 5.3 crore hospital admissions and free treatment worth Rs 61,501 crore already provided under AB-PMJAY, people are being offered health assurance absolutely free of cost. This has led to a huge reduction in the catastrophic out-of-pocket-expenditure (OOPE) on health in the country, which earlier pushed families below the poverty line. These numbers clearly define the pace at which the country is moving towards Universal Health Coverage (UHC) with indefatigable spirit and positivity.
 
The National Health Policy (NHP) 2017 as the guiding document clearly stipulates the path to UHC and emphasises improving the affordability of healthcare services by reducing OOPE on health. India, being a signatory to the 2030 Agenda for Sustainable Development, recognises the importance of improving access to healthcare services by increasing government expenditure on health.
 
Healthcare financing, a mix of government and private sources, is one of the most critical components of a strong and resilient health system. The goal of any health system is to ensure UHC for its citizens, across all the dimensions of services provided and the population covered, and ensuring protection from financial risk. The landscape of the financing structure of India’s health system has evolved in the context of UHC — defined by the trend of increasing Government Health Expenditure (GHE) and a commensurate decrease in OOPE over the last few years, based on available National Health Accounts (NHA) estimates from 2013-14 to 2019-20.
 
GHE in India has shown a consistently increasing trend, from 28.6 per cent to 41.4 per cent as a percentage of Total Health Expenditure (THE) between 2013-14 and 2019-20. In per capita terms, GHE has risen from Rs 1,042 to Rs 2,014 during the same period. The GHE, when expressed in terms of the share in GDP, has also risen from 1.15 per cent to 1.35 per cent during the same period. This amply signifies that the GHE is in tandem with the targets laid out in the NHP 2017. The consistent decline in OOPE as a share of THE from 64.2 per cent in 2013-14 to 47.1 per cent in 2019-20 has been made possible through a corresponding increase in government expenditure on health. This, and a consistent decline in OOPE, indicate that we are moving closer to building a resilient and progressive health system in the country.
 
This increase in government health expenditure is also reflected in the increased utilisation of public facilities, for both inpatient and outpatient care, according to the findings of the National Sample Survey (NSS) on health and morbidity for the years 2014 and 2017-18. Various unique programmes such as the Free Drugs Services Initiative, Free Diagnostics Initiative, Pradhan Mantri National Dialysis Programme, enhanced HRH (human resources for health) allocation, health and wellness services in AB-HWCs, National Ambulance Services, National Health Programmes, including tribal health initiatives, etc, have played a huge role in increasing the utilisation of health services by people.
 
Another critical point worth mentioning is the ever-increasing magnitude of the government expenditure on health. Along with that, the direction of expenditure is towards Comprehensive Primary Health Care (CPHC). The share of CPHC expen­diture has increased from 51.1 per cent in 2013-14 to 55.9 per cent in 2019-20 as a share of the current GHE. There is a renewed focus on CPHC, including a wide spectrum of preventive and promotive healthcare services being delivered through AB-HWCs and dedicated CPHC teams.
 
Evidence suggests that higher the investment in primary healthcare, lesser the need for curative healthcare services, leading to a better return on investment for government finances and better health outcomes for the population (Double / Dual Benefit Approach). Further, the social security expenditure on health in India has increased from 6 per cent in 2013-14 to 9.3 per cent in 2019-20 as a percentage of THE since AB-PMJAY is ensuring financing protection to millions in our country.
 
This evolution of the country’s healthcare system distinctly reflects that health is one of the topmost priorities of the Government of India under the leadership of Prime Minister Narendra Modi. Enhancing financial allocations after a thorough and methodical gap analysis in the healthcare sector echoes the increased ownership of government. This is further confirmed by the fact that the government has allocated additional finances through various channels, especially after COVID-19, to make our health systems more resilient to public health emergencies: Emergency Covid Response Package I and II, health grants under the 15th Finance Commission, PM-ABHIM (Pradhan Mantri — Ayushman Bharat Health Infrastructure Mission), and PM-SSY (Pradhan Mantri Swasthya Suraksha Yojana), health initiatives for the tribal population, Ayushman Bharat Digital Mission. All these initiatives, once fully translated, will result in a strengthened and resilient health system.
 
Along with these visionary initiatives, the Union government has given prime importance to proximate determinants of health through the Swachh Bharat Mission (SBM), Poshan Abhiyaan, Jal Jeevan Mission (JJM), School Health and Wellness Initiative, Fit India Movement, Eat Right India movement, etc. The budgetary allocation for SBM increased by Rs 3,000 crore, for JJM by Rs 10,000 crore and for Poshan Abhiyan by Rs 291 crore between 2022-23 and 2023-24. The attention to coherence and collaboration with other ministries and departments to prevent disease and promote healthy behaviours among community members is clearly visible. This holistic and multi-dimensional approach of the Government of India towards ‘health and wellness’ will surely help the country achieve Universal Health Coverage in the true spirit of ‘Sabka Saath, Sabka Vikas, Sabka Swasthya’.

Mansukh Mandaviya is Union Minister of Health & Family Welfare